Carbon Ion Radiotherapy in the Management of Hepatocellular Carcinoma

Abousaida, Belal; Seneviratne, Danushka S.; Hoppe, B.S.; Ko, Stephen; Asaithamby, Aroumougame; Cucinotta, Francis A.; Kirwan, Jessica; Mody, Kabir; Toskich, Beau B.; Ashman, Jonathan B.; Hallemeier, Christopher L.; Krishnan, Sunil

doi:10.2147/jhc.s292516

Cited by 6 publications

(3 citation statements)

References 55 publications

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“…Contrary to these findings, a retrospective study conducted in 2018 on carbon-ion radiotherapy did not show an impact of sarcopenia on both OS and PFS [100]. Carbon-ion radiotherapy is an external radiotherapy used in several solid tumors, including HCC, that uses carbon particles loaded with energy that can be directed with more precision to the tumor mass [101]. The efficacy of carbon-ion radiotherapy in both sarcopenic and nonsarcopenic patients is probably due to its lower invasiveness and toxicity [100].…”

Section: Impact Of Sarcopenia On Radiotherapy Outcomesmentioning

confidence: 91%

The Negative Impact of Sarcopenia on Hepatocellular Carcinoma Treatment Outcomes

Cespiati,

Smith,

Lombardi

et al. 2024

Cancers

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Introduction: Hepatocellular carcinoma (HCC) represents a major global health concern, characterized by evolving etiological patterns and a range of treatment options. Among various prognostic factors, sarcopenia, characterized by loss of skeletal muscle mass, strength, and function, has emerged as a pivotal contributor to HCC outcomes. Focusing on liver transplantation, surgical resection, locoregional treatments, and systemic therapies, this review aims to analyze the impact of sarcopenia on HCC treatment outcomes, shedding light on an underexplored subject in the pursuit of more personalized management. Methods: A comprehensive literature review was conducted by searching peer-reviewed articles on sarcopenia and treatment outcomes in patients with HCC from inception up to October 2023. Results: Sarcopenia was found to be prevalent among HCC patients, exhibiting different occurrence, possibly attributable to diverse diagnostic criteria. Notably, despite variations in studies utilizing skeletal muscle indices, sarcopenia independently correlated with lower overall survival (OS), recurrence-free survival (RFS), and progression-free survival (PFS) across surgical (both transplantation and resection), locoregional, and systemic therapies, including tyrosine-kinase inhibitors (TKIs) and immune-checkpoint inhibitors (ICIs). Moreover, a link between sarcopenia and increased rate and severity of adverse events, particularly in surgery and TKIs recipients, and larger tumor size at diagnosis was observed. While baseline sarcopenia negatively influenced treatment outcomes, alterations in muscle mass post-treatment emerged as primary determinants of reduced OS. Conclusions: Sarcopenia, either present before or after HCC treatment, negatively correlates with response to it, across all etiologies and therapeutic strategies. Although only a few studies have evaluated the impact of supervised physical activity training on muscle mass and OS after HCC treatment, it is crucial to evaluate the presence of sarcopenia before treatment initiation, to better stratify patients’ prognosis, thus performing a more tailored approach, and identify therapies able to restore muscle mass in HCC patients. Conversely, the impact of sarcopenia on HCC recurrence and extrahepatic spread remains inadequately explored.

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Section: Impact Of Sarcopenia On Radiotherapy Outcomesmentioning

confidence: 91%

The Negative Impact of Sarcopenia on Hepatocellular Carcinoma Treatment Outcomes

Cespiati,

Smith,

Lombardi

et al. 2024

Cancers

View full text Add to dashboard Cite

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“…The patient selection criteria were: (1) HCC confirmed by histology or cytology, or clinically diagnosed by the criteria proposed by the Chinese Society of Clinical Oncology or the American Association for the study of Liver Diseases; 16,17 (2) surgically unresectable, medically inoperable, refusal of surgery, or recurrences after surgery or ablation therapy; (3) Child-Pugh (CP) scores of 5-7 points; (4) Eastern Cooperative Oncology Group (ECOG) performance status of 0-1; (5) no evidence of distant metastases; (6) gastrointestinal (GI) tract not invaded; and (7) absence of uncontrolled ascites. Patients who had previous radiation history of liver, or had another primary malignancy, were excluded.…”

Section: Patient Selection Criteriamentioning

confidence: 99%

“…2,3 In addition, for the last 2 decades, charged particle radiation therapy such as proton radiotherapy (PRT) and carbon ion radiotherapy (CIRT) has been applied in clinical practice and demonstrated encouraging results. [4][5][6][7] Unlike photon modalities, PRT and CIRT have a dose-focusing Bragg peak and much more conformal dose distribution, which could spare the adjacent organs at risk (OARs) more effectively. 8 Besides, carbon ion, as a high linear energy transfer (LET) beam, produces more dense ionizations, causing higher relative biological effectiveness (RBE), along with reduced oxygen enhancement ratio, thus potentially leads to greater cell-killing effects, especially for radioresistant hypoxic tumor cells, which is common in large-size HCC.…”

Section: Introductionmentioning

confidence: 99%

Pencil Beam Scanning Carbon Ion Radiotherapy for Hepatocellular Carcinoma

Zhang,

Cai,

Sun

et al. 2023

JHC

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Purpose Carbon ion radiotherapy (CIRT) has emerged as a promising treatment modality for hepatocellular carcinoma (HCC). However, evidence of using the pencil beam scanning (PBS) technique to treat moving liver tumors remains lacking. The present study investigated the efficacy and toxicity of PBS CIRT in patients with HCC. Methods Between January 2016 and October 2021, 90 consecutive HCC patients treated with definitive CIRT in our center were retrospectively analyzed. Fifty-eight patients received relative biological effectiveness-weighted doses of 50–70 Gy in 10 fractions, and 32 received 60–67.5 Gy in 15 fractions, which were determined by the tumor location and normal tissue constraints. Active motion-management techniques and necessary strategies were adopted to mitigate interplay effects efficiently. Oncologic outcomes and toxicities were evaluated. Results The median follow-up time was 28.6 months (range 5.7–74.6 months). The objective response rate was 75.0% for all 90 patients with 100 treated lesions. The overall survival rates at 1-, 2- and 3-years were 97.8%, 83.3% and 75.4%, respectively. The local control rates at 1-, 2- and 3-years were 96.4%, 96.4% and 93.1%, respectively. Radiation-induced liver disease was not documented, and 4 patients (4.4%) had their Child–Pugh score elevated by 1 point after CIRT. No grade 3 or higher acute non-hematological toxicities were observed. Six patients (6.7%) experienced grade 3 or higher late toxicities. Conclusion The active scanning technique was clinically feasible to treat HCC by applying necessary mitigation measures for interplay effects. The desirable oncologic outcomes as well as favorable toxicity profiles presented in this study will be a valuable reference for other carbon-ion centers using the PBS technique and local effect model-based system, and add to a growing body of evidence about the role of CIRT in the management of HCC.

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